PUPPP stands for "Pruritic Uticarial Papules and Plaques of Pregnancy." In English, this means "really itchy rash gotten by pregnant women." PUPPP typically starts with an itchy belly. Lots of women get itchy bellies when they're pregnant, but women with PUPPP get really, really REALLY itchy bellies. This turns into a rash that starts on the belly, but may spread to the legs, feet, arms, chest, etc. I had hives on my belly, all down my legs, on my feet, and on my arms. PUPPP usually spares the face, and the palms of the hands and the soles of the feet, though I also got a horrible itch on the soles of my feet, so no guarantees there.

They don't know what causes it. And unfortunately for the people who get it, it's not a major research priority because it's not particularly dangerous. (In that it doesn't kill either the pregnant women or the babies.) Just uncomfortable as all hell.

Of course, if you've found your way to this page, it's probably because you have it. (Unless you wandered here from one of my other pages, in which case, I hope you never find out what I'm talking about!) Which means that you know that "uncomfortable" is the understatement of the year. THIS THING SUCKS. Bites. Blows. I remember seriously thinking that if I could, I'd seriously consider trading the PUPPP for something that could potentially kill me but at least wouldn't itch.

I felt somewhat better about my degree of self-pity when a friend of mine with fibromyalgia (which is no picnic, but involves pain and fatigue, not itching) sent me a lengthy sympathetic e-mail saying that he HATED itching, that he viewed pain as preferable. So go ahead and whine. You have every right to.

When I was diagnosed with PUPPP, I went searching on the web for useful information — that is to say, remedies for the itching. I found a couple of pages but they tended to appear and disappear randomly. Also, people would recommend something they'd found useful for quelling the itch, but they wouldn't include the active ingredients, so if I went to Walgreens and didn't find it, I didn't know if it was worth hunting for it, or if I already had an identical preparation in my bag of pharmaceuticals. (I took to carrying around with me a plastic bag with all my anti-itch preparations. I'd rotate, during the day, because if you overapply some of these things, they stop working.)

Anyway, I decided that once I was done with it, if I had time, I would create a web page full of useful information — as close to a one-stop-shop as I could put together. You can e-mail me if you want (naomi.kritzer@alumni.carleton.edu), but I promise you in advance that if I knew of ANY OTHER REMEDIES they'd already be listed. This is what I know. All of it. (Of course, if you find something else that works, please e-mail me the name of the product, the active ingredients, and any commentary about it, and I'll add that to the site.)

IMPORTANT DISCLAIMER. I am NOT a doctor and I do not have any medical training at all. Women who are pregnant or nursing a baby should discuss ANY medication with their doctor or midwife, including herbal remedies and stuff that's available over-the-counter. The purpose of this site is solely to share any information I have about coping with PUPPP, based on my own experiences with various products — not to give medical advice. Please note that there are some other, more serious complications of pregnancy that can also feature intense itching — I do not recommend self-diagnosing. Your obstetrician or midwife should be your guide on this, not me.

Be careful with the over-the-counter products as well as prescription stuff. I've seen Ben Gay recommended for PUPPP relief; Ben Gay/Icy Hot type products have aspirin in them; this can be absorbed through the skin and aspirin is not safe in late pregnancy. Talk to your doctor, talk to your doctor, talk to your doctor.

Sarna or Respite

Active ingredients: menthol and camphor

Effectiveness: excellent if not overused

You can buy either Sarna or Respite; the active ingredients are the same. I had bottles of both: the Respite was easier to carry around because of the way the bottle closed, but the Sarna was easier to squirt into my hand in the middle of the night while in bed (it comes in a pump dispenser). This creates a cooling feeling on the skin and then numbs the skin slightly, easing the itching. This product was one of my best bets for getting at least a little sleep at night, if I could fall asleep before it wore off. Unfortunately, it also made me feel cold. (I hate being cold.) You do not have to worry about the camphor or the menthol being a hazard to the baby; this is non-steroidal. However, if you overuse it, it won't work as well.

Side note: this stuff has a very distinctive smell. I got awfully tired of that smell. While you're in the hospital after the baby comes (assuming you aren't doing a home birth), you might consider making your spouse wash all the sheets and other laundry so that you don't have to smell it anymore.

Update: One fellow sufferer wrote in to tell me that a pharmacist told her that camphor was dangerous to newborn babies. (It could cause seizures.) This is a danger to newborns and not to unborn babies, so far as I know, but remember, discuss this stuff with your doctor.

Caladryl Lotion

Active ingredients: Calamine 8% and Praxomine Hcl 1%

Effectiveness: good but dries the skin

This is also available as an off-brand (the Walgreens store brand is called Calahist). If you are one of those people who believes that the brand name is better, I won't try to dissuade you: if you have PUPPP, any comfort you can get is worth the extra money for the name brand. (If you have a spouse who grumbles that you're wasting money, send him to me. I'll pummel him for you.) This is the pink stuff that you may have used on mosquito bites as a kid; it's usually very runny and it can stain clothes, so be careful with it. (I really didn't care if I stained my maternity clothes, which I loathed by then anyway; I may regret this when I have my second kid.) This works pretty well and makes a good product to rotate with the Sarna. Unfortunately, calamine lotion will dry the skin over time. If you've had your baby and are still itchy, cut out the calamine, as it may just be making things worse.

Solarcaine Medicated First Aid Lotion (active ingredients: benzocaine and triclosan)

Solarcaine Aloe Extra Gel (active ingredients: lidocaine hydrochloride .5%)

Effectiveness: moderate

My obstetrician warned me off of anything that contained a 'caine (lidocaine, benzocaine, xylocaine, etc.) because he said I might develop a "sensitivity" to it. But I doused myself with it anyway because Solarcaine Medicated First Aid Lotion was what I put on all sunburns and most mosquito bites growing up. The childhood faith I had in this stuff increased its effectiveness for me, I think. (If you had a similar preparation, use it now unless it's something like drinking peach schnapps till the room spins.)

Update: Solarcaine Medicated First Aid Lotion seems to have vanished from the market. Alas! Only the green Solarcaine-Aloe stuff seems to be available now.

Aloe Vera Gel

Active ingredient: aloe vera

Effectiveness: moderate

I bought green aloe vera gel from Walgreens and would slather that on, as well. Basically, it gave me something to do, and the aloe vera soothed the itch for a few minutes at least.

I also tried various moisturizers with aloe vera in them. Again, this gave me something to put on. I'm not sure they did any good. I was still itching a week after giving birth, and went to a dermatologist, who told me to knock off the calamine (because it was drying my skin) and the aloe vera (because I might have developed an allergy to it). I hadn't actually (I haven't reacted to it since) but again, if you've had your baby and are still itchy...

Cetaphil Lotion

Effectiveness: n/a

I didn't use this during my pregnancy; this was what the dermatologist told me to use instead of aloe vera stuff, to moisturize my skin. It's probably not a bad idea to use this. It won't do anything to fix the PUPPP, but it will help to keep your skin a little moisturized, so you don't end up itching from dry skin as well. And it can't HURT anything, as it's ultra-hypo-allergenic.

Aveeno Anti-Itch Concentrated Lotion

Active ingredients: calamine 3%, praxomine HCl 1%, camphor .47%

Effectiveness: moderate

I used this for a while and then realized that the Caladryl had a higher percentage of the calamine. It's less messy than the Caladryl, though, and includes some moisturizing ingredients.

Gold Bond Medicated Body Lotion

Active ingredients: Dimethicone 5%, Menthol .15%

Effectiveness: low

I found this recommended on a page of PUPPP remedies and tried it. Someone on that page swore by the stuff, but I didn't find it at all helpful. My bottle of it is almost untouched.

Lanacane Maximum-Strength

Active ingredient: ? (can't remember)

Effectiveness: low

My mother recommended this for itching. I didn't find it to be real helpful, but I used tons of it anyway. This is most effective over a very, very limited area. If you have a few spots that are particularly itchy, try it there. Don't spread it over a large area or it won't work at all.

Extra-Strength Benadryl Cream

Active ingredient: Diphenhydramine Hydrochloride 2%

Effectiveness: low

This was somewhat more effective than the Lanacane, but again, only works over a very limited area.

Hydrocortisone

Active ingredient: Hydrocortisone

Effectiveness: low

This was what I started out using, once my belly started itching really badly. It didn't work very well. Note that this is steroidal, so beware of using gallons in it. (My obstetrician didn't think that I could hurt my baby with the over-the-counter product, unless I bathed in it. Which I would have considered, if it would have done any good. He did also note that it doesn't work real well.) Like the Lanacane, this won't do you much good over a large area.

Myconozole (myselex) -- Yeast infection treatment

Effectiveness: high (according to fellow sufferer who wrote in)

"...I went through my cabinet and tried a little patch test of every cream I could come across that didn't have big pregnancy warnings all over it. None of them cured the rash, but one did make a big difference. Would you believe it was Myconozole (generic brand of myselex-- a cream for yeast infections!) So since then I've been treating this like I'd treat a yeast infection-- avoiding excess moisture, using the cream (I water it down so I can spread a little bit of it everywhere), and also eating yogurt and stuff like that which I use to get rid of yeast. I still itch, and I still have the rash, but this really seems to be helping out. I mean, the itching is actually manageable. The only part of me that really itches bad today is my back-- the only place I couldn't reach to apply the cream this morning."

Band-Aid brand anti-itch gel

Effectiveness: high (according to fellow sufferer who wrote in)

Active ingredient: camphor

"...the product is 'Band-Aid' brand, (formerly Rhuli brand), anti-itch gel by Johnson & Johnson. It is a clear gel, (with a green cap), and dries fairly fast, so it is great to apply at work! Not to mention it is small enough to fit into your purse, so it is convenient to take anywhere. The active ingredient is Camphor (.45%), so it is somewhat similar to the Sarna and Respite (it too cools & numbs the skin). "

Grandpa's Pine Tar Soap

Effectiveness: high (according to several fellow sufferers who wrote in)

"You can get this at your local pharmacy or they can order it for you. You can also find it online. It is cheap, about $2-3 a bar. Use this daily when you shower. Just lather up really good and leave it on your skin for a few minutes before you wash it off. The key to killing this rash is to keep it dry. This soap will help bring it out so do not be alarmed if it seems to be getting worse before it gets better. That is normal. It will; however, disappear in about a week."

"1. Waddle as fast as those pregnant legs can carry you to the natural foods
store and pick up a bar of Grandpa's Wonder Soap with Pine Tar Oil. Or go to
their website, www.grandpabrands.com.
2. In a cool shower, rub the Grandpa's soap all over the affected areas. Then
scrub with a loofah or bath blossom to build up a nice, rich lather. This also
is an excuse to scratch with a safe object, rather than tearing out chunks of
skin with your fingernails at night.
3. After you're all clean, turn off all the hot water. Put the itchy parts
directly under the icy cold water for as long as you can stand.
4. Pat dry and apply a light, absorbing lotion. I love Alba Botanica Very Emollient Lotion, unscented.
5. Keep a bottle of Jason Witch Vera herbal gel on hand if you have a case of
the itchies. I used this at night when I got an itch attack.

I was originally taking three showers a day with the Wonder Soap, morning,
after work, and bedtime. After a few days I was able to go to two, then one
shower a day. I noticed immediate relief from the itching, and within two days
the hives were visibly fading."

"I was covered from head to toe with a rash and it was the worse thing I have ever experienced. I could not sleep and actually I could not stand to be in my own body. [...] I tried one of your remedies - Grandpa's Pine Tar Soap. I think it is a miracle soap. Within the five days of using it two to three times a day along with my cream I can tolerate the rash. It is not gone, but I can at least stand myself. I truly got to the point that I thought I was going to lose my mind."

Baking soda paste

Effectiveness: high (according to fellow sufferer who wrote in)

Active ingredient: baking soda

"The best thing I found was to make a baking soda paste and to rub it everywhere.
It gave me the longest relief." (As a bonus, you probably already have this in your kitchen cabinet and can give it a try right now if you want.)

Tea Tree Oil

Effectiveness: moderate (according to fellow sufferer who wrote in)

Active ingredient: tea tree oil (I assume)

"Another thing I found that worked a little was tea tree oil, but that smelled a lot."

Derma Shield

Effectiveness: moderate (according to fellow sufferer who wrote in)

Active ingredient: Dimethicone

"I found one other lotion which was pretty effective in soothing the PUPPP, especially in areas where it wasn't too dense. The product is called Derma Shield - the active ingredient is Dimethicone. It is a foam, like shaving cream. It's marketed for industrial use, is expensive and hard to find, but you can check out their website at www.dermashieldusa.com." Note - You should probably talk to your doctor before using this. In addition to assessing risks to the baby, the whole point of Dimethicone is to keep stuff from getting on your skin (people use it in jobs where they work with hazardous substances). So if you're using any sort of topical medication, the Dimethicone could be really seriously problematic.

Neutrogena Soothing Relief Anti-Itch Moisturizer

Effectiveness: high (according to fellow sufferer who wrote in)

Active ingredients: camphor (.4% I think), 1% dimethicone,
and 2% lidocaine hydrochloride.

"The one over-the-counter product that I found I really liked was this new lotion from Neutrogena. It can be hard to find since it's new, I couldn't find it at any local drugstores, but I did find it at our Target. It's called Soothing Relief Anti-Itch Moisturizer. It's one of their Norwegian formulas. It claims to work up to 8 hours. I don't think it works quite that long on the insane PUPPP itch, but it does work for quite a while, at least 3 hours or so. It cools somewhat like the Sarna, though not as much, but it lasts a lot longer and doesn't smell funny. I'm not aware of anything else with this mix of active ingredients."

Medicated Witch Hazel

Effectiveness: moderate, according to friend of fellow sufferer who wrote in.

Active ingredients: eucalyptus, clove oil, menthol, and "other good cooling stuff."

"When I had a rash from fire coral I used something similar and it dried up the rash in a few days. My friend tried a little bit and it seemed to help. Since witch hazel contains alcohol, it could dry the skin in the long run. Witch hazel is traditionally used as an astringent."

Corn Starch

Effectiveness: moderate, according to friend of fellow sufferer who wrote in.

Active ingredients: corn starch

"Doesn't stick to the skin very well but it works (temporarily)! The only disadvantage is that you end up with white powder all over the house and bed. Small price to pay for some relief, I think. Doesn't dry the skin to my knowledge."

Boericke & Tafel anti-itch cream

"Anti-itch cream from the makers of ArniFlora: this is a homeopathic medicated cream with an active ingredient that I can't even pronounce, yet remember. I found it at all health food stores near the Tiger Balm shelf. This also seems to work very well. It doesn't seem to dry the skin and it smells very nice."

Tiger Balm

"We haven't tried this but I remember the locals using it on mosquito bites and rashes when I lived in Bali. I tried it myself and it works like a miracle. The only down side is that if the skin is broken it can sting. It should definitely NOT be used on broken skin."

Great Mother's Belly Butter

Originally purchased for stretch marks, found to be helpful with PUPPP. Available on the web at http://www.greatmothersgoods.com/.

Banana Peel

"My mom's boyfriend, who is a little heavy on herbal cures, suggested I rub BANANA PEEL on the hives. Dubious, but ready to try anything considerably safe, I gave it a shot. Well, lo and behold, it works instantly to stop the immediate insane itch, and leaves a soft, comfortable residue after drying. While it doesn't completely cure the itch, it has so far left it bearable to the point that I am NOT scratching. It appears to last about two hours before the best effects wear off. I imagine the ripeness of the peel may also have something to do with the effectiveness. Mine was still yellow, but with lots of brown spots."

Rainier Soapworks PUPPP Relief Soap

Effectiveness: high (according to several fellow sufferers who wrote in)

Tracy, the woman who owns Rainier Soapworks, is herself a former sufferer of PUPPP. She developed her soap specifically to relieve the itching. Tracy wrote in to tell me about her soap, but I several women have also mentioned it in messages about things that helped them. You can order it online.

Kirk's Original Cocoa Hardwater Castile Bar Soap

Effectiveness: moderate (according to a fellow sufferer who wrote in)

"What I have tried is a soap that I bought at the Cracker Barrel Store. The Soap is called Kirks Original Cocoa Hardwater Castile Bar Soap. I shower at least twice a day with it. It's got a great lather and rinses off really clean. After the shower, I usually feel relief for quite some time. After I dry off, I put on Aveeno Anti-Itch concentrated Lotion. I like the lotion, because it doesn't dry the rest of my skin out like regular calamine did. No point in itching from PUPPP along with itching from dry skin! I know some people don't like the lotion, but maybe the combination with that soap works well together." This soap is available online.

Noxema Cream

Effectiveness: high (according to a fellow sufferer who wrote in)

"What seemed to help me was to lather myself with Noxema Cream. It has both camphor and menthol, it totally soothed the itching, I had to reapply it once in one area, but it did the trick."

Olive Oil or Aloe Vera applied to wet skin

Several people have written in to suggest moisturizing treatments (olive oil in one case, pure aloe vera in another) applied to skin while still wet from the shower. Both said that applying the moisturizers to damp or wet skin was key.

First, a word about getting these prescriptions. I had my baby with a midwife (my HMO has a midwife practice and you can choose an obstetrician or a CNM for your delivery). I really liked having midwives for my prenatal care and for the delivery, and highly recommend that to anyone. However, if you have PUPPP, you will need to get an appointment with someone who has an MD (probably either an OB/GYN or a dermatologist), because midwives cannot prescribe these things.

I was very glad that I got these prescriptions from an obstetrician rather than a dermatologist, because I had a lot of confidence that the obstetrician would not prescribe anything at all unsafe for the baby. However, some obstetricians know nothing about PUPPP. (In which case, you could try asking about the drugs listed below. Your obstetrician can look them up in the PDR, the Physician's Desk Reference, and can prescribe them for you. The thing about getting a referral to a dermatologist is that you'll typically have to wait at least a couple of days for an appointment, and if you have PUPPP, you aren't going to want to do that.)

Triamcinolon cream or ointment

Active ingredient: Triamcinolon 0.1% (a steroid)

Effectiveness: high

This is a steroid cream or ointment, but a weak one that should not pose a danger to you or the baby. Be careful not to wear a tight bandage over the ointment (and this may be true of the cream as well) because it can press it in through the skin and get it into your system. (This can also be a problem with socks, but you probably don't really want to be wearing socks anyway — see coping techniques, below.) I found the cream more effective but the ointment easier to spread. DO NOT put this on more often than directed. Used properly, this CAN make the PUPPP go away entirely.

Note for those with crummy insurance coverage — this stuff is cheap.

Hydroxyzine Hcl 25 mg

Active ingredient: Hydroxyzine (an antihistimine)

Effectiveness: high for putting you to sleep, at least for a week or two

This is an oral antihistimine of the "sedating" variety. (Apparently some people find Benadryl, available over the counter, to be more effective; talk to your doctor about this.) The website I found with medical information about PUPPP said that while this may not have much effect on the itching, it will usually put you to sleep, and that in itself can be beneficial for PUPPP sufferers. I know that sleep was my single biggest issue. The dosage was 1-2 tablets: I took 1 ever four hours during the day, and 2 at night.

Like many sleeping pills, this loses effectiveness over time. (If you're taking it solely for the antihistimine effect, the fact that it doesn't keep making you drowsy is a PLUS. But for me it was definitely a minus.)

One random note. The night I went into labor, I had been sent home from the hospital with a sedative called "Visteril" to help me sleep. After discussing it with my doula, I decided not to take the Visteril. Just as well, because I was back at the hospital, in active labor, two hours later. I found out AFTER delivering my baby that Visteril is simply a brand name for hydroxyzine. So even if I HAD taken the Visteril, it probably would have had no effect on me at all, because I'd been taking the hydroxyzine for weeks by then and it no longer made me sleepy.

Fluocinonide ointment

Active ingredient: Fluocinonide 0.05% (a steroid)

Effectiveness: Excellent

This was another topical steroid ointment, but a more powerful one than the triamcinolon. Although the hives had mostly faded, one week after my baby was born, my feet were still itching like crazy. (The soles of my feet, even, which are not normally affected by PUPPP.) I requested and got a referral to a dermatologist. Some possible treatments were still out of the question for me, because I was nursing. However, he did think this stuff would be okay. The pharmacist recommended that I not wear socks while this was on my feet, because they could press the steroids in the ointment into my skin, causing me to absorb them systemically. This stuff (combined with the fact that I was no longer pregnant) worked VERY well, and I was back to normal by a week later.

Clobetasol cream

Effectiveness: Excellent (according to fellow sufferer who wrote in)

"[My Dermatologist] prescribed clobetasol cream (which from what I read is similar in strength to the fluocinonide) and I'm 100% better a week later. I almost never itch, and when I do it's not that crazy, insanity-causing puppp itch, it's more like a dry skin itch, or a mosquito bite. The rash is fading, and I may be able to wear shorts this weekend! My only concern is I'm now not quite 38 weeks, but you can only use the clobetasol for two weeks."

Claritin combined with Pepcid AC

"After trying topical creams for a couple of weeks with no effect whatsoever, my dr put me on Claritin and Pepcid (yes the heartburn med) for a total histimine block. I had resetvations about taking meds and finally did b/c my blood pressure was shooting up. She sat down with her drug book and went over everything with me. Within a few days the rash was gone and didn't come back for the duration of my pregnancy. I think I only took the meds for a week."

"Wanted to tell you that Claritin helps as well as Pepcid AC. I did not know it, but Pepcid has an antihistamine in it as well. My doc gave me 2 20mg tablets a day."

Note -- Claritin is now available over-the-counter.

Zyrtec

"After weeks of non-sleeping, crying... I went to my gyn and said I wanted to have the baby. He prescribed ZYRTEC, an antihistimine. I took one half of the little pills and the itching disappeared in a minute!!!!! My God, what a relief!!!!!!!!!!"

Oral steroids

Effectiveness: Mixed (according to fellow sufferers who've written in). Most find that they work extremely well; a few find that they don't do anything at all.

Oral (or injected) steroids were the thing I desperately wished I could have, when I was nine months pregnant and going insane from the itch. When you're not pregnant and you develop a rash as awful and persistent as PUPPP, doctors will frequently give you oral Prednisone or a steroid shot. They're reluctant to give them to you when you're pregnant, though, because steroids work by depressing your immune system. And your baby's immune system is your immune system, at this point. And no one wants you to give birth to a newborn with a depressed immune system. Hence the hesitation to give steroids to pregnant women.

But some women who've written to me were given oral steroids. Most found a tremendous amount of relief from them. One woman, however, had some bad reactions herself to the steroids, and got no relief from them at all. (And the reaction she had was a bad, permanent reaction.)

If your doctor has offered you oral steroids to treat your PUPPP, consider the potential side effects and ask about the risks to both the baby and yourself. Steroids are pretty serious drugs. For information, you can ask to see the PDR (Physician's Desk Reference) that will talk about the risks to you in a fair amount of detail. Also, every Obstetrician has (or should have!) a drug reference that talks about what's known about the risks of each drug to the unborn baby. Drug companies don't do a lot of large-scale studies on pregnant women for obvious reasons. However, they do gather data on studies on pregnant animals, and studies of pregnant women who took the drug anyway -- by accident, or before they knew they were pregnant, or because they were in dire straits and had to have the drug. That's the data that's compiled in the handbook of prescriptions for pregnant women. You can ask to see this, and see what it says about steroids. (I don't know what it says about steroids, honestly, as I don't own a copy of this.)

I don't want to make you totally paranoid about steroids. I think that on average, doctors tend to be a little overly cautious about prescribing drugs for pregnant women when the condition is non-life-threatening. And steroids are the recommended treatment for some other conditions of pregnancy (like gestational herpes). But, be an informed patient.

Sleeping Pills

One of my biggest issues when I had PUPPP was that I couldn't sleep. The prescription antihistimine helped with this a little bit for a while, but was really not very effective as a sleeping pill. When I was in labor with my second child, I needed to spend the night at the hospital and didn't think I'd be able to sleep, and the midwife offered me a sleeping pill (Ambien). She said that it's considered very safe in late pregnancy, and that she routinely prescribes it to women in late pregnancy who complain about not being able to sleep.

So I took it, and in my case, well, it made me hallucinate. But then again, it turned out I was in late labor at the time.

Anyway, what I realized recently was that if I had explained to my midwife that the PUPPP was keeping me from sleeping at all (and I had a number of nights where I was literally up all night, alternating with nights where I crashed for at least a few hours from sheer exhaustion), I think she probably would have given me sleeping pills that would have knocked me out. I didn't think to ask, because I don't normally take sleeping pills. However, I think that it would have been a very good time to use them. (Though maybe not Ambien. Hallucinations on top of itching would not have been good. Most people do not hallucinate from Ambien, though -- it's way down on the list of side effects in the product insert.)

There are a number of sleeping pills that are considered safe during pregnancy, and if PUPPP is keeping you awake I would encourage you to talk to your doctor or midwife to see if they are willing to give you a sleep aid.

Unfortunately, this is probably not a good option for women with post-partum PUPPP. I breastfed and coslept, and you cannot cosleep if you're taking sleeping pills. Even if your baby is not in your bed, you'll have a hard time waking up for feedings if you've taken a strong sleep aid.

Oatmeal Baths

Oatmeal baths are supposed to be soothing. You can buy packets of the stuff from Aveeno (there's also a Walgreens brand), or you can use ordinary oatmeal processed in the blender. I bought packets. (It seemed more drug-like.)

My bathtub wasn't big enough to fully immerse myself in, especially 9 months pregnant, so I used extra towels to soak and drape over my stomach.

I quickly learned not to drain the water after I was done with my evening bath. In the middle of the night, if I woke up and was going crazy scratching, I'd get up and get back into the bath (or at least immerse my feet and legs). I kept a couple of content-free magazines (Glamour and Cosmo) by the tub to read at 4 a.m., and when I was drowsy again, I'd try going back to bed.

Cool or cold showers also help, but I found that they stimulated my skin more than baths did. (Which is not what you want.)

One fellow sufferer wrote in to say that she found relief only from hot showers. I found that hot showers made it worse, but like so many other things, your mileage may vary.

Another fellow sufferer wrote in with this advice: "Do NOT under any circumstances use an oatmeal bath in a whirlpool tub. I was so delusional with itching that I did just this. It is has been two years since my pregnancy and if we turn on the jets in the tub we find the occasional black oatmeal mold make its way into the water. The first time my husband turned it on our tub was filled with black GROSS mold. We can laugh about it now, but at the time...not funny."

Another fellow sufferer wrote in to suggest saltwater baths; she found some relief (using quite a lot of salt).

Ice Packs

When you have PUPPP, the biggest issue is often getting some sleep. You can't very well take the bathtub to bed. (If you can sleep in your tub, go for it, but I couldn't.) Ice packs will stop the itching temporarily. In fact, I found that I could take an ice pack and put it over the skin every time I wanted to scratch it; this satisfied my need to DO something about the itch, without making it itch more.

You can take a non-drippy cold pack to bed with you. I highly recommend the re-usable cold packs from ACE, which have a cloth-like cover instead of plastic. Get LOTS. The ACE cold packs are good for about a half an hour; I would rotate my cold packs in and out of the freezer. When I woke up in the middle of the night, I'd take the thawed cold pack back downstairs and swap it for a fresh one.

Cold Wet Washcloths

Dealing with the itching at work is a whole nother issue, and you may or may not have somewhere to keep more cold packs. One thing you can do in a pinch is to go to the bathroom, wet a washcloth with cold water, and drape it over your belly or legs for a few minutes. I kept a washcloth in a plastic baggie so that it didn't drip over everything else. (I was lucky enough to have a private bathroom available to deal with this sort of thing at work. I'd say at the very least, you have total justification to use the big handicapped stall.)

A fellow sufferer who wrote in suggested that wet paper towels and ice cubes, used one at a time, could also help in a pinch.

Trying Not to Scratch

Don't scratch. Yes, I know. I scratched too. But TRY not to scratch. And cut your nails! Cut them really short! This minimizes the damage you can do to yourself. Not only can you give yourself scars, scratching really, truly, honestly makes the itching worse.

When my baby was 2 1/2 months old, my legs were still marked up pretty badly. The scars faded completely, but it took a while.

One fellow sufferer wrote in to suggest putting socks over your hands at night, to encourage you to rub instead of scratching, at least.

Minimally Restrictive Clothes

I got the rash on my feet right away, and I wasn't able to wear real shoes for the rest of my pregnancy. I wore sandals with no back strap, and I kicked them off when I wasn't walking somewhere. I also wore no socks.

Fortunately, my work environment had pretty minimal standards for dress. (I was working at a university, in the technology department, and could get away with walking back and forth to the bathroom in bare feet.) You may need to talk to your boss, because any clothing that will rub the rash (like shoes) will make the itching worse.

Air Conditioning With No Blanket

If it's summer, you'll want to keep the A/C on (if you have it) and minimize the use of the fan. The air blowing across your skin can stimulate it, making the itch worse. (That's what I found some nights. Other nights, I thought the fan was helpful. Your mileage may vary.) I kept the blankets off me as much as possible.

Soft Flannel PJs

If it's winter, you may need to wear PJs to keep from freezing. A fellow sufferer wrote in to suggest very soft cotton flannel PJs; they irritated her skin less than anything else she'd found.

Self-Hypnotism

Right after I broke out in the rash, I read a childbirth book called "Birthing From Within." The author talks about how she feared a long labor, so she made up this rhyme for herself, which went:

I will only be in labor for as long as it takes
To make, bake, cool, and frost a chocolate cake.

...And that's exactly how long her labor took. (Actually, it may have been frosted right around the time she started pushing, but close enough.) I thought, well, hmm. It worked for her with her labor, maybe it'll work for me with my rash. So while lying in the tub, I would tell myself, "The rash is going away. The rash is going away." And the hives DID in fact fade. The itching got better, though it didn't go away entirely.

Incidentally, because I was thinking about this, I kept getting her rhyme in my head as well. And I had a 5 1/2 hour labor. So it's worth a shot.

Induction of Labor

My obstetrician offered to induce labor if I really couldn't take the rash one minute longer. I declined. I had heard that pitocin labors are often more painful, and I wanted to birth without medication.

Then I almost had to have pitocin anyway, because I went post-term and they were worried that the amniotic fluid volume was low, etc. (Read my birth story, if you're interested in the details.) Anyway, I felt strongly that I wanted to avoid pitocin, but if you're planning on an epidural anyway, you may not feel as strongly about this as I did. Frankly, I think PUPPP is grounds for induction of labor if it won't endanger the baby. Ask about the risks of induction, though; if you have an induced labor you are more likely to wind up having a c-section.

In a midwivery mailing list archive, after the hives had mostly gone away, I found some postings about using dandelion root tincture to cure PUPPP. The theory here was that PUPPP is caused by your liver doing something it isn't supposed to do; dandelion root tincture is supposed to be a liver tonic. I got a bottle of dandelion root stuff at a local health foods co-op, but didn't notice that it helped (but then, the steroid ointment had mostly made it go away by then).

This is almost certainly worth trying, if you can get ahold of it. (Don't just go digging up the dandelions in your backyard, unless you're SURE they haven't been exposed to weed-killers. Dandelions won't hurt your baby — some people eat them as food — but herbicides sure aren't going to do either of you any good.) If there's a store nearby that sells herbs, or organic vegetables, they might know where you could get ahold of this.

Here are reports from a few fellow sufferers who tried the herbal remedies:

"Anyways, I decided to try to beat the systemic problem / the cause of the rash and itching instead of the result. I spoke with someone who worked in a nutrition store who made her recommendations. I started this a couple of weeks after giving birth and noticed some results quickly. The rash was gone by the second week of doing this. But because I have not kept up with it like I should, I still tend to itch tolerably a little bit, but have no rash.

Here is what I did:

Dandelion root pills -- three 3 times per day

Flaxseed Oil -- 1 tablespoon in a protein shake per day (This is to provide the Essential Fatty Acids that were apparently missing from my diet and lending to the problem.)

Apis (a homeopathy) -- 4-5 pellets 3 times per day"

"I wanted to let you know that I tried dandelion root capsules for my PUPPP (got them at GNC for $10.00) I have never used homeopathic medicine before and am generally skeptical of such things. But... I started taking them on Saturday. On Tuesday, my rash was noticibly less intense and today (Wednesday) it has actually begun to CLEAR UP in some areas!!! I got 5 hours of sleep last night! I have to say, the dandelion seems to be the answer - at least in my case. I'm taking the GNC brand, 500 mg. I've taken 2 tablets, 3 times per day."

"I then tried the flaxseed and dandelion root mix. I took 1 flaxseed vitamin 3 times a day and 2 dandelion
3 times a day. After about 2 1/2 weeks of this, the rash began to fade. By the 4th week, it was
completely gone. I still had dry skin which caused some itchiness, but at least the rash was gone."

One other fellow sufferer wrote in to say that she tried the dandelion root tincture but she started it at the sametime as she got a fairly heavy-duty prescription ointment, and while the rash went away, she thought it was because of the ointment, not the dandelion.

There are other herbal remedies out there that may be helpful. However, I just want to note that just because something is herbal does not necessarily make it safe. There are guides to herbal remedies that will tell you whether an herb is toxic, what the risks are, and whether any studies have been done on the herb. Pharmacists usually have these guides; there are other qualified people who may be able to guide you. I am not an herbalist, any more than I'm a doctor.

I've heard from several fellow sufferers who vouched for homeopathy:

"I’m not sure of the ingredients, but he tailored the medicine according to my symptoms. He had never heard of PUPPP either, but the treatment (oral drops) worked within two days. By the time a week had passed I had no more symptoms and was left shaking my head wondering if the whole experience had been just a bad dream after all. I know there are some wacko practitioners out there but in general homeopaths are underrated."

"To your list I would like to add homeopathic medicine that finally worked for me: Urtica Urens CH5 (or 9) plus Sulfur C30. These completely stopped the itching and my upper body cleared up. My legs still look horrible (I am in the 38th week), but at least the itching is gone... I also used baking soda, a lotion with menthol and zinc (prepared by the chemist) and calendula cream."

"Out of TOTAL desperation I went to a homeopathic doctor. She gave me these little pills to take and a soothing cream, made of aloe vera I think. I had to keep the cream in the fridge and it felt awesome and cooling against my skin. By the next day - 5th July - it got worse and I was almost giving up on it.The only thing that stopped me was that when I called the doc she asked me to give the medication 48 hrs. From the 6th onwards there was a notable difference. MOST IMP the itch was under control. I dont know what was in the pills, but you can post the Drs details on your website as she has promised to answer queries from others who have the same problem. Her email address is padmajaps{at}satyam.net.in. Her name is Dr Padmaja Pai Shenoy. I hope this might help someone else."

"To your list I would like to add homeoathic medicine that finally worked for me: Urtica Urens CH5 (or 9) plus Sulfur C30. These completely stopped the itching and my upper body cleared up. My legs still look horrible (I am in the 38th week), but at least the itching is gone... I also used baking soda, a lotion with menthol and zinc (prepared by the chemist) and calendula cream."

Several fellow sufferers have had dermatologists prescribe UVB (light) therapy; some have found it very helpful ("After ten consecutive days of light therapy, it was gone.") Others have tried light therapy without a lot of success. I don't actually know what this treatment involves (is it like a tanning bed? A light box for people with Seasonal Affective Disorder? Could you just go lie out in the sun for a while if it's summer where you are?) but definitely ask your doctor about it.

There are some new prescription-only lotions and creams that have come on the market in just the last couple of years, for people with eczema or psoriasis. Two I've heard about are Elidel and Protopic. One fellow sufferer who wrote in seemed to be getting some relief from these. You might consider asking your doctor about these. However, because they are very new (I think) there may not be much information available yet about their relative safety during pregnancy.

There are a couple of conditions that are sometimes misdiagnosed as PUPPP. If you suspect that you have one of these other conditions, you should go back to your doctor and ask, because they require different treatment. Two conditions that are sometimes confused with PUPPP are described below. (Again: I am not a medical professional, and I am not encouraging you to self-diagnose. But these are all rare conditions, and some doctors have simply never seen them before. It's always good to be an aware, informed patient.)

Herpes gestationis

Despite the name, this has nothing to do with herpes simplex. Herpes gestationis starts out a lot like PUPPP, but then starts erupting into blisters (Yeah, and we thought WE had it bad...) Here's a web page that talks about it in a lot more detail, and includes pictures: http://www.emedicine.com/DERM/topic178.htm

Intraheptic Cholestasis of Pregnancy

ICP is a much more serious problem than PUPPP, so if you think you have it, you should immediately go back to your doctor and ask for a test of liver function. ICP causes generalized itching, rather than a rash. (The itching will start first, probably over your entire body, and although your skin will be red where you're scratching it, any rash will be caused by the itching, rather than inspiring the itching.) If NONE of the remedies help you even a TINY bit, except for cold baths and cold packs, suspect ICP, because you may not be dealing with a skin condition but a larger physical condition. ICP is caused by a liver malfunction that creates a buildup of bile salts. This is VERY dangerous to the unborn baby. If you suspect that you have ICP, you should insist on a blood test that will properly diagnose it. You will probably need steroid injections (to speed development of the baby's lungs) and an early, induced delivery. You can read a lot more about ICP here: http://www.geocities.com/truthav1611/icp.html

Hypothyroid

"I developed an itchy rash postpartum after the delivery of my second child. It didn't let up even after I stopped nursing him. Initially, my dermatologist diagnosed PUPPP, however, after closer scrutiny, I was found to have a thyroid condition which can cause an itchy skin rash. Synthetic thyroid hormone has been taking care of the problem and is safe for use in pregnancy and while nursing. Just another avenue to consider for those suffering."

One of my fears before childbirth was that the itching would drive me crazy. In particular, I worried that I wouldn't be able to cope with the pain of labor because I'd be trying to cope with the itch.

This turned out to be a groundless fear. I had a teacher who used to (jokingly) suggest that I cure headaches by having someone stomp on my foot, and this principle definitely applies. I absolutely did not notice the itching AT ALL from the time I went into labor until sometime the day after I gave birth.

One warning about epidurals, though. Sometimes they cause generalized itching. Bear that in mind before you request one. For me, that would have been worse than labor pain.

For some women, the rash vanishes without a trace within hours after the birth. For me, the rash was already mostly gone, but the itching wasn't...and it didn't go away right away. My feet were still itching a week later (the SOLES of my feet, which is very weird for PUPPP). If you're still suffering a week later, see a dermatologist; he or she may be able to prescribe something stronger.

And some women don't develop PUPPP until just after the birth. (I've gotten quite a few e-mail messages from women to whom this happened.) Again, see a dermatologist, as the restrictions on treatment are not as bad as they were when you were pregnant.

Remember, though, that there ARE other causes of itching. A couple days after the birth, I thought it was getting WORSE again, because now my hands were itching. Then it occurred to me that I had been washing my hands with soap about every hour or two, and not putting moisturizer on them. Basically, I had dishpan hands. I started using hand lotion and THAT problem, at least, went away.

Some of these remedies may cause dry skin; use a moisturizer like Cetaphil to help with that.

Two and a half months after the birth, I still had a lower tolerance for itching. I had the standard winter-dry-skin problem, but I scratched my skin a lot more fiercely than I used to. Which of course made me itch more. There isn't much you can do about this other than being aware of it. If you scratch, scratch gently. And if it's winter, be sure to moisturize! I use vegetable oil on my skin as well as lotion, and Lansinoh (purified lanolin) on particularly itchy spots.

If the PUPPP does not go away, you may want to go back to the dermatologist. If the dermatologist tells you, "if you're breastfeeding, I can't give you anything," be aware that the PDR does NOT have a whole lot of useful information about medications and breastfeeding mothers. Instead, it just says for everything, "not to be taken when breastfeeding." This is to cover the drug manufacturers' butts. A much more reliable source of information on drug safety while breastfeeding is the book Medications and Mother's Milk by Dr. Thomas Hale. Dr. Hale has a website that is also a good source of information (note - at time of this writing, it had been hit by a virus, and much of the information was unavailable, but hopefully this will be temporary) at http://neonatal.ttuhsc.edu/lact/.

I did save some of the information from that site on steroid use, since topical steroids are the main treatment for PUPPP. This is information from Dr. Hale on steroids and breastfeeding:

[on oral steroid use]: Short term steroid use, even high doses such as 120 mg of prednisone, don't apprently cause any undue problems for the infant. Seems the steroid molecule is one that passes into milk very poorly. I would not worry about using it. Your infant stands more risk from formula feeding than the steroid.

Most topical [steroids] are so poorly absorbed transcutaneously, that they never really attain significant plasma levels in mom, so they never end up in milk.

[on triamcinolone]: Only minimal amounts of triamcinolone are absorbed systemically via the skin with most triamcinolone preparations. I would not be overly concerned with its use for this amount of time while breastfeeding. Remember, steroids in general have a terribly difficult time getting into milk in the first place.

This combination [hydrocortisone plus antibiotic ointment] is a common practice. As long as you use vanishingly small amounts, then its not likely to ever bother your infant. Using it 3-6 times daily should be no problem. Again if you see the ointment, you've probably used too much...so use only small amounts. The classic symptom of steroid overuse in an infant would be a peroral rash (around the mouth) of the infant. I seriously doubt you will ever see this.

[Regarding cordicosteroid INJECTIONS]: Small amounts of corticosteroids do get into breastmilk. Doses as high as 80mg/d orally produce insignificant absorption in the infant (<0.1% of the maternal dose). In small doses and for short intervals, most steroids are not contraindicated in mothers of nursing infants. For high doses, especially for long intervals - steroids do have some concerns... they may inhibit bone growth, weaken bones and cause stomach ulcers. Brief use of higher dose steroids are probably not contraindicated but would require evaluation of risks in each specific case. I am not sure how high a dose of steroid your doctor is considering using - or how long a duration the "injection" the doctor is considering. I would inquire about specifics.

So honestly, in retrospect, I probably didn't need to be as paranoid about the fluoncinonide as I was (going sockless and so on).

One fellow sufferer who was given oral steroids after delivery wrote in with this piece of advice: "My word of caution to anyone who has this issue while trying to breastfeed: regardless of what they may/may not say… your baby will most likely suffer the same effects as you. My baby is constantly hungry (one of the major side effects of prednisone). I finally figured it out that she’s just hungry and not colicy or having acid reflux."

Here are some other sites that talk about PUPPP.

New Zealand DermNet PUPPP page - http://www.dermnetnz.org/dna.puppp/puppp.html

A good overview of PUPPP, including a very good picture that you can compare your rash to.

eMedicine's PUPPP page - http://www.emedicine.com/derm/topic351.htm

eMedicine provides an excellent online medical reference book. It's only partially completed, but the entry on PUPPP is available.

Gentlebirth Archive PUPPP information - http://www.gentlebirth.org/archives/puppp.html and http://www.gentlebirth.org/archives/miscdisc.html#Itchy

I found this site late in my battle with PUPPP and didn't try most of the remedies. However, the information here is interesting and you might find something that helps you.

Another woman's personal experiences - http://home.earthlink.net/~tnk/pregnancy/pqapuppp.html

This woman found relief from something called Zonalon Cream. I have no idea what the active ingredients are. Apparently you can only use it for a week if you're pregnant, but that might get you through the worst of it.

BabyCenter.com's pregnancy itching tips - http://www.babycenter.com/tips/9450.html

This is a page of various people's personal remedies for itching. You'll notice a distinct split. There are people here who think that cocoa butter and olive oil are helpful. These women did not have PUPPP (and when I had PUPPP, reading their advice made me want to throw things). There are also people here who DID have PUPPP. I made a list of every suggested remedy and went looking for them at my local drugstore. Of course, that was back in September of 2000, and additional ideas have been posted since then.

I'm only about halfway through my pregnancy but I itch like crazy. Could this be PUPPP?

Yes, unfortunately, it could be PUPPP. Some women develop it very early. (You should probably press for a test of your liver function, though, as early itching can also be Intraheptic Cholestasis of Pregnancy (ICP) which is a hell of a lot more dangerous than PUPPP. See above for more info on ICP.) The good news is that most women seem to find that PUPPP runs its course after a while (particularly if you get prescriptions for a good steroid ointment and an antihistimine) so you are not necessarily doomed to suffer for the whole rest of your pregnancy.

I gave birth last week -- and just started itching. Could this be PUPPP?

Yes. Some women get it postpartum, though your obstetrician may tell you this never happens. Ask for a referral to a Dermatologist, as you have treatment options that a pregnant woman does not (see above).

Will I get PUPPP with future pregnancies?

No one knows the answer to that question. Chances are good that you won't. PUPPP is mostly an affliction of first-time mothers. But sometimes it happens, and you do have a higher chance of developing PUPPP than a mother who didn't have it with her first pregnancy. Whether you want to pursue pregnancy when you could develop PUPPP is a decision I would urge you not to worry about while you're still pregnant. Even women who don't have PUPPP often decide they never want to have another baby during their ninth month of pregnancy, only to change their mind a year or two later.

When I became pregnant with my second child, I was very, very paranoid about developing PUPPP. I bought dandelion extract capsules and Cetaphil moisturizer. I was absolutely religious about using Cetaphil on my belly; I took dandelion capsules any time I thought I was starting to get itchy, as well as for the last two months of pregnancy and for a month after I delivered. And, I am happy to report that I did not get PUPPP with my second pregnancy. So maybe the dandelion extract prevented it. Or maybe I was just in the majority of women who don't get it twice. I figured the dandelion couldn't hurt, though, and my midwife agreed.

One more reminder: I am not a doctor, nurse, pharmacist, herbalist, homeopath, or any kind of medical expert. I am a mom who had PUPPP during her first pregnancy. Do not use my site to diagnose yourself. Do not assume that treatments suggested on this site are safe during pregnancy. Use the information here as a starting point for a discussion with your doctor, midwife, pharmacist, or other trained professional. I hope you find something that helps you!

Naomi's Motherhood Site • Naomi's Writing Site